Accommodative spasm with bilateral vision loss due to untreated intermittent exotropia in an adult.

BACKGROUND Intermittent exotropia (IXT) is an exodeviation intermittently controlled by fusional mechanisms. Patients with IXT may present with asthenopic symptoms, blurred vision, headaches, diplopia or visual confusion and reading difficulties; especially after prolonged periods of near work. OBJECTIVE To report the presentation and management of a young adult with intractable accommodative spasm secondary to long standing intermittent exotropia. CASE The patient was found to have bilateral accommodative spasm with high pseudomyopia and severe impairment of vision. There was a tendency for recurrence with discontinuation of cycloplegics. CONCLUSION A total relief of symptoms was noticed after strabismus surgery was undertaken for the exotropia. A detailed orthoptic evaluation with emphasis on recognizing accommodative spasm as an unusual presentation of IXT, could aid in appropriate diagnosis and treatment of such cases.